Provider Demographics
NPI:1861988198
Name:BOWYER, DEVIN ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:DEVIN
Middle Name:ALLEN
Last Name:BOWYER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6985 SW HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-5204
Mailing Address - Country:US
Mailing Address - Phone:817-999-5396
Mailing Address - Fax:
Practice Address - Street 1:11790 SW BARNES RD STE 280
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5935
Practice Address - Country:US
Practice Address - Phone:503-626-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10846122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist